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Subclinical Atherosclerosis Burden by 3D Ultrasound in Mid-Life: The PESA Study.

Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain; Hospital Universitario Central de Oviedo, Asturias, Spain. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain. Philips Healthcare, Madrid, Spain. Banco de Santander, Madrid, Spain. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain; IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain; Hospital Clínico San Carlos, Madrid, Spain. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, New York. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, New York. Electronic address: vfuster@cnic.es.

Journal of the American College of Cardiology. 2017;(3):301-313
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Abstract

BACKGROUND Detection of subclinical atherosclerosis improves risk prediction beyond cardiovascular risk factors (CVRFs) and risk scores, but quantification of plaque burden may improve it further. Novel 3-dimensional vascular ultrasound (3DVUS) provides accurate volumetric quantification of plaque burden. OBJECTIVES The authors evaluated associations between 3DVUS-based plaque burden and CVRFs and explored potential added value over simple plaque detection. METHODS The authors included 3,860 (92.2%) PESA (Progression of Early Subclinical Atherosclerosis) study participants (age 45.8 ± 4.3 years; 63% men). Bilateral carotid and femoral territories were explored by 3DVUS to determine the number of plaques and territories affected, and to quantify global plaque burden defined as the sum of all plaque volumes. Linear regression and proportional odds models were used to evaluate associations of plaque burden with CVRFs and estimated 10-year cardiovascular risk. RESULTS Plaque burden was higher in men (63.4 mm3 [interquartile range (IQR): 23.8 to 144.8 mm3] vs. 25.7 mm3 [IQR: 11.5 to 61.6 mm3] in women; p < 0.001), in the femoral territory (64 mm3 [IQR: 27.6 to 140.5 mm3] vs. 23.1 mm3 [IQR: 9.9 to 48.7 mm3] in the carotid territory; p < 0.001), and with increasing age (p < 0.001). Age, sex, smoking, and dyslipidemia were more strongly associated with femoral than with carotid disease burden, whereas hypertension and diabetes showed no territorial differences. Plaque burden was directly associated with estimated cardiovascular risk independently of the number of plaques or territories affected (p < 0.01). CONCLUSIONS 3DVUS quantifies higher plaque burden in men, in the femoral territory, and with increasing age during midlife. Plaque burden correlates strongly with CVRFs, especially at the femoral level, and reflects estimated cardiovascular risk more closely than plaque detection alone. (Progression of Early Subclinical Atherosclerosis [PESA] Study; NCT01410318).

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Publication Type : Multicenter Study ; Observational Study

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